Confused at blood test results - any ideas please

[Britman]

I just got some blood test results today and was expecting high LH and FSH since I have always had small firm testes which would seem to indicate klinefelters/primary hyogonadism.

I'm now 29 and have usual low testosterone symptoms inc obvious ones like poor erections compared to when I was 18/19 and only need to shave every 3/4days. Anyway went to doctor and he said I was being a hypochondriac which really p'd me off but I wasn't surprised based on other peoples experiences. He reluctantly agreed to test for few hormones I mentioned and results are below.

N.B I eat well and exercise moderately 4 times a week usually jogging/gym - always had a thin frame and lack of muscle definition - 5ft 10 and just under 12st

Blood test taken 10:30am few days ago;

LH - 4.5 U/l (ref range 2-10U/l)
FSH -4.7 U/l (ref range 1-7 U/l)
Prolactin - 168 mU/l (ref range 50-360)
Oestradiol - 18 pmol/l (ref range 25-85)

still waiting on Total testosterone and SHBG results from same blood test

Also had Thyroid and Haemotology blood test in Feb 2008 - some figures:

Free T4 - 15.4 pmol/l (ref range 10.2-19.6)
TSH - 1.53 mU/l (ref range 0.3-4.0)
Hematocrit - 44% (ref range 40-55%)
Hemoglobin - 14.9 g/dl (13.2-16.2)
Platelet count - 185 (150-450)

I'm not sure if these results could still indicate I am primary - does anyone know if these results for LH and FSH may have been above the ref range if I had the blood test say 8:30am?

Also my oestradiol (do not know if ultrasensitive method was used - assume not since not requested) looks to be very low no doubt as a direct result of low testosterone which, once I get my results for this will indicate.

I have very low platelet count as a result of low testosterone which I notice in that any cuts I get take longer to heal.

would appreciate any thoughts on results above specifically with regards to LH and FSH and whether or not they could still indicate primary or would they definitely be much higher regardless of the time the blood test was taken?

Thanks in advance

[pmgamer18]

Can't say with out your testosterone levels if you noraml or high your LH and FSH would be like this. You levels for LH and FSH would only be on the higher side is your levels were low and your testis were not making enough then you would see very high levels. If your LH and FSH were low with your Estradiol low then you could have a pituitary problem. So with out your T levels it's hard to say.
For your Thyroid you needed to have Free T3 done also to tell. I don't think your Estradiol labs are the right ones where do you live in the UK there range is much higher normnal would be 73 pmol/L and = to 20 pg/ml in my units so your very low here this means something is wrong and this will kill your libido and give you ED.

[Britman]

Thanks for your respone pmgamer18 - I live in Scotland. I will post my total testosterone level when I get it. I would expect it to be low normal at best because my testicles are very small and thats what led me to think it must be primary.

On your point about pituitary problem - could this really be the case here since my LH and FSH values came back normal (mid range)? - would I not expect them to be lower than this?

and just from a basic non-medical view I would expect to see my testicles swell if I restrained from ejaculation for say just over a week which doesn't happen

I understand that if I was primary I would expect to see these values at least at the top of the ref range but I not all that clued up in the variation of LH and FSH over 24hr period apart from they are higher during sleep and secrete in pulsatile fashion.

[pmgamer18]

All I am saying is if your testosterone levels look good above mid range this is why your LH and FSH are mid range your brain is not asking for more testosterone because your don't need it. If your Testostereone comes back low very low this then might be a pituitary problem. Still need to see your testostreone levels.

[Britman]

Hi folks,

Got Total Test & SHBG results as below. Testosterone is right at bottom of range as I expected and doctor has ok'd my results sheet sent out to me even although I explained my symptoms to him and said my test would be a guaranteed low before doing the blood test.

Clearly he doesn't understand and that really annoys me. I plan to continue my research for now so I can back up what I say to him at next visit with cited evidence to medical journals/textbook.

I'm based in UK so I know I face more of an uphill battle in getting help from GP's so hence I'm doing proper research. Also I like to know about things rather then rely on what someone else tells me who could be a complete bullsh'ter for all I know

One thing that surprises me is that my brother has same symptoms as me and also has small testicles therefore from the research I have done already I thought it must be klinefelters/genetic problem causing my low T but I did not get high LH & FSH to back this up which seems odd - maybe the FSH & LH would have been high at 8-8:30am had the test been done then??


Any of your thoughts/comments greatly appreciated

Cheers



Blood test taken 10:30am;

LH - 4.5 U/l (ref range 2-10U/l)
FSH -4.7 U/l (ref range 1-7 U/l)
Prolactin - 168 mU/l (ref range 50-360)
Oestradiol - 18 pmol/l (ref range 25-85) = 4.90 pg/ml (optimum/ideal ref range 20-35 pg/ml)
Total testosterone 10.4 nmol/l (ref range 10-36) = 300 ng/dl (AACE ref range 280-800 ng/dl)
SHBG 19 nmol/l (ref range 13-70 nmol/l)

Also had Thyroid and Haemotology blood test in Feb 2008 - some figures:

Free T4 - 15.4 pmol/l (ref range 10.2-19.6)
TSH - 1.53 mU/l (ref range 0.3-4.0)
Hematocrit - 44% (ref range 40-55%)
Hemoglobin - 14.9 g/dl (13.2-16.2)
Platelet count - 185 (150-450)

[pmgamer18]

Your very low on Testosterone and Estradiol and I woud test your Ferritin and Iron levels.
Here are some link in the UK that might help you.
Testosterone Deficiency Center - Hypogonadism -
Untitled Document

[Britman]

Thanks for your comments pmgamer - I will obviously need to get a few things tested if I am to find out the route cause of my low levels.

Biggest hurdle is getting doctor(s) to listen. I can only hope any endo I see realises I have very low levels which should be looked at because my doctor clearly does not.

I'm going to get as much info together as I can to back up what I say to him at next appointment.


I had seen the website you provided link for before - Slough is bit away from where I live. I will need to track down endo in central Scotland - if a decent one exists!

[pmgamer18]

Well you have a good dam good start now just find a good Dr. see what's doing this and treat it test again to see if your levels come back up. If you find you are primary or secondary then get on TRT. Get your levels up into the upper 1/3 of your labs range and keep your Estradiol low.
Here is a good link to read.
Male Hormone Modulation Therapy.. HGH replacement, Testosterone Replacement

[1cc]

Britman,

Your lower platelets are because of your low estradiol levels. When your estradiol goes up, so will your platelets. Your total testosterone is low. When you start TRT, your T will go up and so will your estradiol, because some of the T also converts to estrogen.

The quickest way to resolve your problem is to see a good doctor. One of the top HRT doctors in the world lives in Belgium. His name is Dr. Thierry Hertoghe. He also has a sister called Theresa Hertoghe in the same business in Belgium and he has also trained other doctors in Europe. You can either try to see him or his sister, or perhaps they can refer you to someone in the UK that they have trained. His contact details are below. Good luck.

Hertoghe T
Van Beverlaan 9
1180 Ukkel
* tel 02 736 68 68
* fax 02 732 57 43

PS. It will probably not be necessary to see him too many times in person, if you are concerned about the distance. It may be possible to do some of the consults by phone after the initial in person visit.

[Britman]

Thanks for the info guys

1cc I don't have the money spare to afford going to Belgium and if I went on TRT I would want consultations every month for first 6 months then at least every 6 months thereafter.

Maybe somewhere down the line I might need to seek out consultants outside scotland/uk but I think I would still need a referral from my GP anyway? this would prove difficult no doubt.

Wish doctors in uk were more up on this subject because there seems to be a serious lack of knowledge from medical profession on this which you would think any endocrinologist worth their salt would have a good understanding of the best treatment options.

also Im surprised prostate biopsies and CT-PET scanning dont feature more given the fear of promoting any existing underlying breast/prostate cancer a patient may have - no doubt this is due to cost and ignorance on the part of doctors